Perioperative and Postoperative Classification of Surgical Complications of Penile Prosthesis Surgery

Background: The aim of this study is to adapt the two most common grading systems of surgical complications; the Satava system for perioperative complications, and the modified Clavien grading system for the postoperative complications on the surgical complications of penile prosthesis surgery. Methods and Findings: Between Oct 1990 and Dec 2011, 422 patients were treated with penile prosthesis implantation (PPI). We categorized the procedures as follows: A: Malleable PPI, B: Inflatable PPI, (B1: for 2 piece inflatable penile prosthesis (IPP), B2: for 3 piece IPP), C: Dual implantation with an artificial urinary sphincter (AUS), synchronously or metachronously (C1: A+ AUS, C2: B1+ AUS and C3: B2+ AUS). We classified the intraoperative complications according to the Satava system and the postoperative complications according to the modified Clavien grading system. The mean age was 58(40-74). The numbers of overall intraoperative and postoperative complications were 21 and 45, respectively. The distribution of intraoperative complications was; 13/21(62%), 6/21(29%) and 2/21(9%) for Grades 1, 2 and 3, respectively. The distribution of postoperative complications were; 0, 5, 1, 39, 0, 0 and 0 for Grades I, II, IIIa, IIIb, IVa, IVb and V, respectively. Conclusion: Satava grading system works well for classifying intraoperative complications of PPI but the modified Clavien classification cannot afford a reproducible and even grading system for classifying postoperative complications. A standard method for classifying postoperative complications of PPI surgery is lacking and deserves more investigation.